title: Steps towards preventive HIV treatment in Fujian, China: problems identified via an assessment of initial antiretroviral therapy provision.
abstract: BACKGROUND
  At the end of 2009, a total of 501 AIDS patients were receiving antiretroviral therapy (ART) in Fujian Province in China, yet there were no assessments to determine treatment efficacy and HIV-1 preventive potency under the current health care delivery system.
  
  
  METHODS
  During the period of 2005-2009, we assessed the outcomes of initial ART by following up 381 patients for 12 months in Fujian Province. CD4⁺ T-lymphocyte (CD4) count, plasma viral load (VL), and patient characteristics were analysed. The results were compared between 4 groups divided by the baseline CD4 values at the 25, 50 (median), and 75 percentiles.
  
  
  RESULTS
  Over three-quarters of the subjects reported heterosexual contact as the probable route of transmission. After 12 months of ART, CD4 recovery varied between the 4 groups (P < 0.001), but VL sharply declined regardless of the baseline CD4 count (P = 0.136). Although this VL decline indicates the potency of ART as an HIV-1 prevention tool, the time between positive diagnosis and ART initiation suggests serious delay in both diagnosis and treatment; the medians of periods for the lowest and highest baseline CD4 quartiles were 1.2 and 9.6 months, respectively.
  
  
  CONCLUSIONS
  Current limitations in VL determination make it difficult to assess the efficacy of initial ART, and delays in diagnosis and treatment suggest that subjects contributed to HIV-1 transmission while they were not receiving ART. The current National Free ART scheme does not provide free treatment for sexually transmitted infection (STI), and there is no link between ART and the STI care delivery system. This may interfere with the HIV-1 preventive potency of ART. We highly recommend establishing a collaborating mechanism with STI care, strengthening the VL determination system, and promoting HIV tests and early ART initiation.
authors.affiliation: Department of STDs & HIV/AIDS Control and Prevention, Fujian Center for Disease Control and Prevention, Fuzhou, Fujian Province, China ; Department of International Health, Institute of Tropical Medicine and Global Center of Excellence Program, Nagasaki University, Nagasaki, Japan.
authors.forename: Pincang
authors.initials: P
authors.lastname: Xia
authors.forename: Junko
authors.initials: J
authors.lastname: Okumura
authors.forename: Pingping
authors.initials: P
authors.lastname: Yan
authors.forename: Meirong
authors.initials: M
authors.lastname: Xie
authors.forename: Shouli
authors.initials: S
authors.lastname: Wu
authors.forename: Meizhu
authors.initials: M
authors.lastname: Zhuang
authors.forename: Jian
authors.initials: J
authors.lastname: Zheng
authors.forename: Chunyang
authors.initials: C
authors.lastname: Zhang
authors.forename: Mingya
authors.initials: M
authors.lastname: Zhang
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.forename: Guoxi
authors.initials: G
authors.lastname: Cai
authors.forename: Taro
authors.initials: T
authors.lastname: Yamamoto
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000517:prevention & control*; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D011785:Quality Assurance, Health Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D019380:Anti-HIV Agents